Account Sign In

Thanks for confirming your Username. As a result of some recent security enhancements,
your web account with Username is no longer accessible. To access your account information,
you will need to create a new web account with a unique username.
If we can help you create this new account, please contact our Customer Care Center at 833.226.3785.

Find Other Services

GEHA Newsletters & Updates

Coordination of Benefits

If you or any other family member has other coverage that pays for your dental expenses in addition to GEHA, please complete the information below and select Submit Form to send this form by email to GEHA.

Employee or Annuitant Identification Data

To help us identify your account, please provide the following information.

Street Address*City*State/Province*Zip Code*Email Address*By providing your email address, you agree to receive email news and information from GEHA.
You have the ability to opt out from within any email communication you receive from GEHA.

Other Group Coverage Information

Are you or any other covered family member actively employed any place other than the federal government? Yes
* No

Family Member First NameFamily Member Middle InitialFamily Member Last NameEmployer NameEmployer AddressEmployer CityEmployer StateEmployer Zip Code

Are you or any other family members covered under any other group health or dental insurance plan? Yes
* No

Policyholder First NamePolicyholder Middle InitialPolicyholder Last NameRelationship to GEHA Member

Does this plan include dental coverage? Yes No

Is this other coverage Single coverage Family coverage

Is this person Employed Retired

Retirement DateOther Carrier NameOther Carrier Phone NumberWhat is the policy number, contract number or group certificate number of other policy?

Please list family members eligible for other group coverages belowEffective Date*FEHB Plan NameFEHB Code

Signature

By entering my name below, I certify that the information furnished by me is true and correct to the best of my knowledge and belief.Member Signature*Date